Why Vision Problems Are Often Missed and How to Build Vision Skills at Home with Dr. Juanita Collier

What if the problem isn’t “just reading,” “just behavior,” or “just getting older”? What if it’s your eyes?

In this episode, Denise talks with Dr. Juanita Collier, founder of 4D Vision Gym and host of the It Could Be Your Eyes podcast. Dr. Collier shares her own story of growing up with an undiagnosed eye turn and explains why so many visual problems are still missed today, even when someone has “20/20” vision.

They discuss how hidden vision issues can affect reading, attention, confidence, behavior, concussion recovery, stroke rehabilitation, and even relationships. Dr. Collier also explains how carefully designed at-home digital programs can help rebuild the visual system when in-office care is hard to access.

If you or someone you love has been told everything is “fine,” but you know something is not right, this episode is for you.

Dr. Collier's website: https://www.4dvisiongym.com/index.html

I'd love to hear from you! Click the "If you liked this episode, CLICK HERE" link above to send me a message. Your comments, questions, guest suggestions, and topic ideas come directly to me as Fan Mail, and I read every message.

Transcript

Denise: Welcome to the Healing Our Sight podcast. I'm your host, Denise Allen, and today I have with me Dr. Juanita Collier, and she is the founder and CEO of 4D Vision Gym, based in Cheshire, Connecticut. As a nationally recognized leader in behavioral optometry and vision therapy, she has over 15 years specializing in post-concussion care and pediatric visual development. With her team, she is the creator of the 4D built line of digital vision therapy programs serving families and practices across the U.S. additionally, she is the host of the It Could Be Your Eyes podcast, educating professionals and parents nationwide. And I have been following “It Could Be Your Eyes” for a long time. Dr. Collier.

Dr. Collier: Oh, great. That's wonderful to hear. Thank you.

Denise: Yeah, it is so fun. I'm really happy that we can share all of your story and background and expertise with our listeners today. And I wanted to start with just having you share a little bit about your journey into vision therapy and what led you to start your podcast.

Dr. Collier: So, I got into vision therapy because when I was younger, I apparently had an eye turn my whole life, and the doctors never actually checked for it. I knew that I wasn't seeing properly. So, you know, my sister got glasses and I was like, obviously, this is what I need. And so, she was looking at the chart, and she was saying all sorts of crazy letters. And I'm like, okay, that's what I need to go do. So, then it was my turn and I started just making up letters. And the doctor, you know, pulled my mom aside and she's like. And yeah, she's lying, so she's fine. Just need any glasses. I'm like, no, I need something. Something's not right here. And so, I kept going back year after year, and he kept saying that vibration was perfect. I had eagle eyes. And I knew that I did not like reading. And my mother had the same diagnosis, too, but she didn't know until after I was in optometry school. And so, she was like, oh, well, when you are studying, you need to write down every word that's in the chapter. So, you write down the entire textbook, and that's how you actually get yourself to study. Then we would do speed reading. So, she was like, okay, so you have to, like, read to the sound of the waves. That was like on tapes back in. Back in the 80s. But yes, so we would do speed reading. We would do all these things to make it so that we were able to, like, get as much information in as possible. And so, it helped because I still graduated at, you know, the top of my high school class. And went to an Ivy League college and graduated early and then went to optometry school. But it was just a lot of work, and nobody ever tested me for anything until we were testing each other in optometry school, and everybody was like, oh, look at Juanita's eyes. Look at his eyes. And so, we saw that I had this eye turn, corrected it with vision therapy in a few weeks, and it's something that could have been corrected. I started complaining about it when I was 8 years old. And so being in optometry school and seeing other kiddos kind of going through that same thing, I, you know, made it my mission to have vision therapy be accessible to everyone in the world who needs it, which is essentially everyone in the world that would benefit from it. And so, I feel like that's a tall order. But most people don't even know that the things that are going on with them, like reading difficulties or difficulty driving or difficulty retaining information, and things like that could actually be stemming from a visual issue. So that's why we started the it could be your eyes podcast, so that we could speak directly to the public and have them understand that what they're experiencing might not be normal, might not just be your new normal, as everyone likes to say, and that it could be a visual issue that can be corrected. Right.

Denise: Well, and when they say new normal, it can be after some kind of an injury, right?  And you say, oh, that's how my eyes are going to be from now on, and just not true.

Dr. Collier: And that's what essentially every stroke patient hears, every concussion patient hears. And even people who have had an injury to their visual system. But, like, for me, I thought that this was my normal too. Like, oh, my new normal is that I have to read to waves and I have to write down everything that's in a textbook. And I was a biology major. That was a lot of writing. And so, you know, it's like, you know. But that was my new normal because that's how I had to learn. And I didn't realize that that wasn't what was actually necessary, and it was something that could be fixed in weeks.

Denise: Was your problem being fixed in weeks unusual or. I. I mean, I feel like a lot of people take longer than a few weeks to overcome an eye turn.

Dr. Collier: So, I just had convergence insufficiency, which was like. It was convergence insufficiency that decompensated into a full exotropia. So, a full I turn out. So, I was able to have perfect depth perception. I was Able to pull things together. It was just maintaining it that was difficult for me. And so, once I learned, oh, this is what I need to do, then my brain was like, okay, we got this, and then it was over. And so, yes, it's not normal to have it be fixed that quickly, but because I had already been trying so many different things, and my mother was doing her own kind of forms of vision therapy with having me really work my visual motor integration skills, and that was helping me retain information with the speed reading that was essentially auditory visual processing that she was training me on her own ways and not knowing that was actually vision therapy. So, I guess technically I've had vision therapy for quite some time, but the actual convergence movements were trained in optometry school.

Denise: Okay, that makes sense now, because we don't talk about them as two different things necessarily, Convergence insufficiency and just a regular strabismus. But it does affect the way that you approach it. Right. And the amount of time that it takes. Yeah, I love that so much that I'm glad you that you clarified that it was convergence insufficiency, because I have talked about that on my podcast. Separate from, you know, a regular esotropia. Exotropia, kind of.

Dr. Collier: Exactly. Yes. Yes. Esotropia is much harder to correct because usually you don't really have that time of alignment. And so, a turn that's intermittent is going to be a lot easier to treat than a turn that's constant. So, for me, my turn was worse when I was tired or if I was reading for a really long time, things like that. So, most of the time I was able to control it, which is why I was still able to be so successful academically. But then that would have been easier had it been treated much earlier.

Denise: Right?

Dr. Collier: Yeah.

Denise: You had to work much harder than normal.

Dr. Collier: Exactly. And so, I didn't do ball sports. I was a cheerleader. And so, things like that, you know, I made compensation, so I was still an athlete. And cheerleading is a sport no matter what anyone says. So, I was still an athlete on that.

Denise: Absolutely.

Dr. Collier: Yeah. But not ball sports.

Denise: Yeah, I. I still have issues thinking about doing ball sports, even though logically I should be able to now. People have asked me, well, why haven't you tried pickleball or whatever? And I just can't make myself do it.

Dr. Collier: Exactly. I have no interest. And that's the thing. But it's like, maybe I would have if that was something that was fun to me when I was younger.

Denise: Okay, well, I'm glad I'M not the only one.

Dr. Collier: That's awesome.

Denise: We've talked a little bit about how things that people are experiencing, they don't connect to vision. What do you hear in your practice when people come in, as far as that goes?

Dr. Collier: So even though I've, you know, been in practice for almost 20 years now, we still are hearing people not realizing that reading is so reliant on you, your eye teaming, and your ability to use your eyes together. Because parents take their kids to their pediatrician and they're just checking distance vision, which isn't really important for academic learning. And even at the nurse's school screening, same thing, it's just distance vision. So, when we're looking up close, that's when the kiddos are having these problems and they don't really know that what they're seeing is different than what their peers are seeing. So, they just think that they're not good at reading, or they just think that, you know, this person's smarter than them. So, we see a lot of kids with confidence issues. We see a lot of kids who don't want to even walk into the school building because it's just so hard for them to perform academically. We see a lot of kids who act out in the classroom, and oftentimes they're diagnosed with attention issues or behavior issues when actually they're seeing double when they're reading and you're trying to them to read. So now they're going to do something that's easier for them or they're going to try to get attention in a way that doesn't make them feel like they're not smart. So, a lot of times we'll see a lot of attention issues overlapping with vision issues. And so, we'll see a lot of times that kids perform so much better academically and are so much more compliant in the classroom when their vision issues are treated. We had one little girl. She. She had just started kindergarten, and her mom got a call saying that, you know, she keeps purposely stepping on people's feet and she's getting in their personal space and she's blowing raspberries at them and spitting on them in the face, and she needs to go have a psycho valuation because they don't know what's wrong with her. And the mom calls hysterical, and she's like, my daughter is the sweetest girl in the world. She would never purposely step on anyone's feet. Like, I think something's going on with her vision. But they said that she has 2020 vision. Like, but I heard Something about you, maybe you might see something different. And she had an eye ting issue. She had such poor depth perception that she didn't know how close she was to these other people. And we gave her glasses for it and it was like the slightest little prescription. It had some prism in there to kind of stabilize her visual environment so that she was able to see centrally and also process information that was peripheral to her. And I guess they got them at a Lens Crafters in the mall. When they walked out of the Lens Crafters, the girl looks at the floor and she says, oh, wow, the lines between the tiles aren't moving anymore.

Denise: Oh, wow.

Dr. Collier: Exactly. And so, things like that, where it's like this poor mom, like she. Thankfully, she knew that her daughter wouldn't do those things, but she didn't know to complain that the lines on the tiles were moving because that's how she's always seen them. So, she didn't actually have any behavioral issues. She had a vision issue that was causing her to misinterpret her environment.

Denise: Yeah, that's huge. I love that you have made a big impact with your podcast. So, do you have a lot of people reaching out to you because they have heard you on your podcast?

Dr. Collier: Yeah. So, it's been really great because we have so many people across the world listening to our podcast, which is so cool. Cause it's like I'm from a little small town in Connecticut and I even started my practice in my small town in Connecticut in. So now having people around the world, you know, learning from me and hopefully getting help and finding people near them to be able to help their vision issues and help their kids and their families and their partners and everything, that's just been so amazing. And we had one group of tutors in Cuba, New York, which I've never heard of before. It's very. We were like, oh, it's New York. We'll come visit because we're in Connecticut. It's fine. It was like an eight-hour drive. It was absolutely horrible. But it was fun. So, we went there because they heard our podcast and they had so many kids who were struggling with reading that they weren't able to help. And they each had, you know, 30 years of experience as, as special ed teachers, reading tutors, all of these things. But there was something missing. And the closest behavioral optometrist to them was two hours away. So even if they thought that it was a vision issue, they weren't able to get, get, get their kiddos help. And so, they contacted us and we Taught them things that they can incorporate into their classroom to help with tracking and to help with focusing power and things like that. Because then these kids are getting the skills that they need so much younger and being able to actually thrive academically and thrive with reading. Because back I think it was 10 years ago, one of the superintendents that we were working closely with let us know that the private jail system determines how many jail cells to be in a particular area based on the literacy rate in third grade. Wow. So. Exactly. And so, we're thinking that that's a statistic that they're using to understand how to invest millions and millions and millions of dollars. Then we're really setting up a system. If children are not able to read appropriately in third grade, we're setting them up for failure going forward. And so, anything that we can do to help these kids get the interventions that they need earlier, the better. Right?

Denise: Yeah. Well, it sounds like there should be some interventions in the jails, too.

Dr. Collier: Yes. And there's been a lot of jail studies. So, a lot of the juvenile delinquent studies show that recidivism decreases if they have vision therapy while they're in jail and everything. So, it's. It's very interesting. The behavioral optometrists who have made that as part of their practice.

Denise: Right. So that's not something that you've done. You've been working with the schools, rather, is that right?

Dr. Collier: Exactly. We're working with the schools and the teachers.

Denise: Yeah.

Dr. Collier: I have not. I have not gone into the jail system, but there are other doctors who do.

Denise: We can only do so much. Right?

Dr. Collier: Exactly. You're.

Denise: You're doing so much already. So, as you've talked to these people in places that are out away from vision therapy, you came up with another resource for them, right?

Dr. Collier: Yeah. So actually, what happened is during COVID kids were on screens so much, it was crazy. And it hasn't really stopped since then. But when we were finally able to open again after Covid, our wait list was ridiculous. And, you know, we couldn't be there every single day. Like you said, we have other things in life that we need to be doing. And I have kids, and so does Jess, and it was just a lot. So, we developed a program for our wait list because the visual systems developed. So, the people that we're seeing have had hiccups in their visual development, and that's why they have the vision issues they have. And so we developed a program that was really training that underlying development of the visual system so that during those 12 weeks when they were, you know, waiting to get into our in office schedule, they were actually able to build up those skills so that then when they came in, in 12 weeks, they'd kind of hit the ground running. And then we can fly through vision therapy. And what we found was that a lot of the kiddos that came back in didn't end up needing vision therapy after. And so, their tracking issues were gone, their focusing power issues were gone, their eye teaming issues, eye turns, like lazy eye, all of that had been resolved in that 12-week program. And that was kind of shocking to us because we didn't, we knew that they would get a little bit better, but we didn't expect things to be completely resolved. But when you look at the neurology of the brain and development and visual development, it makes sense that treating things and taking them through the normal developmental cycle should fill in a lot of those gaps for a lot of the kids. And that's what happened. And so, we presented our work at the COBD conference and now we've been able to kind of spread it all around the country. So, we have people In, I think 12 states doing our programs now. And it's just been really, really great because we're helping so many more kids. And that's our built to read program. And then our adults in the office found out that we were helping the kids this way and they were like, oh, where's my next question? Yeah, exactly. Because a lot of head trauma patients, what they see is that they have good days and they have bad days, and sometimes their appointment in the office would be on a bad day and so they'd just be sitting in a dark room with our vision therapist just doing nothing because that was their appointment time. But then they'd have a Good, you know, 45 minutes or so at home that they weren't able to do their vision therapy. So, they really wanted a program that they would be able to work around their schedule. Also, after Covid, we noticed that our patients, our stroke patients were younger. So, we had a lot of 50-year-olds getting strokes. And I don't know if there is the correlation there, but they don't have rides because 70-year-olds have rides, because they have kids who can drive them and are not trying to drive their kids to kindergarten and things like that. But 50-year-olds don't really have anyone to transport them. And so, them having this program got a lot more adults to get the help that they needed because a lot of times they're like, oh, I just can't do it because I can't get there. And so now we had a program for them, our built for life program, that really was a. Able to be built around their lives so that they could spend 10, 15 minutes a day working on their visual systems, getting their visual systems to where they need to be so that then they could get back to work, they could get back to driving themselves, they could get back to being on the computer for the full work day and not needing to kind of be on disability and things like that, because they had this tool at their fingertips.

Denise: Wow, that is so amazing. Do you require that it's being used with a doctor's office? Because you have it for your office and you're assuming that people are coming in and they're going to see you. So, is it designed that it needs to be used only with a doctor?

Dr. Collier: So, everyone needs to have an eye exam because we need to make sure there's no pathology and that they're wearing the correct prescription.

Denise: Okay.

Dr. Collier: A lot of people do not have access to a behavioral optometrist, because if they did, then we wouldn't need our programs. So, they don't have access to a behavioral optometrist. So, we can't really require that they have that. But we. They do need to have an eye exam, because if there is some other thing going on, if there is a brain tumor or a brain bleed or anything like that that's causing these difficulties or contributing to them, we don't want to mask it by treating their convergence. And so, they do need to have a recent eye exam in order to do any of our programs.

Denise: Okay, but then if they've done that, they can do your program, and they may get a result where they wouldn't need vision therapy potentially. Right?

Dr. Collier: Exactly, exactly. Because we're tracing back through the normal neurodevelopmental process for the visual assist system, and that is very similar to the rehabilitative process of the visual system.

Denise: Okay, so that's what. Why you're saying that the stroke victims and the TBI victims can use your program as well? Yeah.

Dr. Collier: Okay.

Denise: Did you adjust it for adults so that it's different than for children, or is it the same program?

Dr. Collier: Oh, no, it's. It's completely different. And it's longer because adults have compensated much, much more embedded than a child. So, with a child, it's kind of like easy to pull off the layers and, you know, fix everything. But adults have been compensating their whole lives, and a lot of times after a brain injury, they're kind of re triggering vision issues that they compensated from, for from before. So, our adults will come in saying now they have double vision and, and you ask them had they ever had that before. And it's like, oh, when I was like 8, and it's like, okay, so you figured out how to get rid of it, how to compensate for it. But now your brain has gone through this huge trauma, and it has to devote its resources to healing that and it can't compensate for the vision issues that you had from before. And so that way, now we have to kind of take care of the brain injury and also treat what was there prior to. So usually, our patients are saying that their better, they're seeing better, they're interacting with their environment better than they were prior to their brain injury.

Denise: That is amazing. It's kind of like the brain injury was a trigger for them to be able to have the opportunity to improve because they wouldn't have even realized they had a problem without the injury.

Dr. Collier: Exactly. Yes. That's the bright side of having a brain injury is that, you know, that's one way to look at it.

Denise: I think there's always a bright side.

Dr. Collier: Right.

Denise: Do you have a specific story that you can share that's maybe a favorite one?

Dr. Collier: So, for our brain injury patients, we had one woman who, she fell down this like cement stairs. She was very petite, maybe like five, two, very skinny. She fell down cement stairs and got a brain bleed. And she was married but no kids and I believe she was 34 years old. She's on one of our podcasts and she couldn't even sit across the table from her husband because him eating, like the motion of him eating and the chewing, the disconnect between the visual and the sound of him chewing would make her like nauseous. And she couldn't hold his hand when they were walking down the street because it was like a disconnect between her vestibular system and her visual system. And so, she did vision therapy with us and she was only there for like three, three, maybe four months. And so, for us we're like, oh my goodness, that's so fast. You had a full-on brain bleed, and you couldn't work and all of these things. And she describes it as being so long that she was in treatment and how long, because when a patient is experiencing, it's every single day that they're struggling, whereas as a doctor, we're like, oh, wow, you finished in four months. Some people don't get referred to us until they're like eight months out and then they're here for a year. And so we thought this was a huge win. But it was really interesting seeing her perspective of the timing versus ours. But what she said at the end was, you know, you gave me my marriage back. And that's not something that we thought vision therapy was going to do. And so, we have these things all the time that are kind of just like, wow, like your visual system contributes to, to everything. Because we didn't know about the chewing, we didn't know about the hand holding. Like, all of that came up after when she was describing how we gave her marriage graph. Because that was a, it's a weird statement when she's graduating from vision therapy, just like, oh, you, my marriage rack. I'm like, don't know what that means. But then when she described it, it was like, wow, that's really something we wouldn't even consider as being part of the issues that she was having.

Denise: Absolutely. Yeah. I, I, I don't think anyone would have considered that a visual issue would create that kind of friction in a relationship.

Dr. Collier: Exactly. Yeah.

Denise: Amazing. So, can you give an idea of what kinds of things people should be watching for so that they know that it may be their eyes?

Dr. Collier: So, I think that a big thing after a stroke is the, you know, they're older people usually. So, if we're thinking about like our 70, 80-year-olds after a stroke, a lot of times they'll go to their eye doctor and say that they can't read. The eye doctor will check and say, you're 20/20, you can read. And the answer is like, no, they actually can't read because if you check their eye movements, if you see how they're tracking, they're having such difficulty just moving their eyes across in a straight line or going from one to another in space. And those are the skills that we're using when we're reading. So, if we're thinking that this population, they're not working anymore, they're not playing sports, they're not doing like, a lot of times they're not driving. Most of the time that they're spending is reading. And now they can't do that either.

Denise: Yeah.

Dr. Collier: So, this is a big life change for them. And then they go to the doctor, and the doctor is essentially that you're crazy, you can read, you just, just go read. So, when we see these patients, we are able to, you know, correct their tracking eye movements. And now they're able to do this thing that was like one of their only Joys that they were still able to do, especially after a stroke. And so, when your parents are telling you that this is what they're experiencing. So, you know, as like a 40, 50-year-old, when your parents are telling you that's what they're experiencing, dive a little bit deeper into it. And the 50-year-old patients that, that parent, kids that are bringing their parents in to us, they're like, you know, my mom was a nurse, she was an ER nurse, she was a surgeon. She was this, she was that. This is not her. So, can you bring my mom back? And then, you know, we're coming back to like, well, now I'm reading chemistry books for fun. Again, like, that's not, I don't think that's fun for anybody. But okay, I'm glad that we helped you.

Denise: Yeah, well, what people find fun can definitely differ, but it's giving them their life back that way.

Dr. Collier: Exactly. So, I think that for, you know, the people who are taking care of that older generation, really keeping an eye out for what they're saying their symptoms are and not attributing everything to old age. Because I think that that's what tends to happen with our, our older generation. That it's kind of just like, oh, you're old. That's why you can't see, that's why you can't read, that's why you can't do all these things. And that's not necessarily true. And people are living so much younger, so much older now that to tell somebody at 75 that this is just how it's going to be until forever and that might be 20 years, you know, that's really an unfortunate prognosis to give a person and taking away their hope is unnecessary. Maybe you don't know how to help them, but maybe somebody else does. So, you know, as the caregiver for them, really seeking out who that person is that might be able to help them.

Denise: Yeah, that's amazing. I think for me, I've had a lot of exposure to the strabismus support groups and there's kind of a pervasive thought process in there that you only go to the ophthalmologist and then you do surgery and then you do patching and you know, how do I get my child to wear a patch? And all of the alternative things that those doctors will recommend. And they may look at vision therapy as something that doesn't work. And I think particularly a home program they're going to be skeptical of. Right. And there's all this talk about, well, I did vision therapy, now I have permanent double vision, and it didn't work and all of those things. How do you address that when someone's saying, well, what do you mean? I can just do it at home? Or how do I know it's going to work? And that kind of thing.

Dr. Collier: I think that we need to go back to what was the cause of the strabismus. Why did you know, this baby feel like it needed to turn their eye in or out, or have one eye be so much more, have so much more of a prescription than the other eye? And it's all the adaptations that we make to protect ourselves. And our brain is constantly trying to protect ourselves. So, as we're moving through this world or as we're being moved through this world, we need to figure out what is the way that we keep ourselves safe. And you know, that goes into the primitive reflexes and integrating those and everything like that too. But usually, people are not thinking about their vision in that same way. But you get the majority of your information from your environment through your visual system. And so that information needs to make sense. And if your brain can't make it make sense, that needs to figure out some other way to still be able to function. And so if that means that, oh, the world makes a lot more sense if my eye is turned in all the time, or the world makes a lot more sense if my eyes turned out all the time, or the world makes more sense if I just use one eye versus the other eye and, or trying to use the two eyes together, then that's what they're going to do. And so, with our digital programs, we're not going in and saying like, oh, let's force you to use your two eyes together immediately. You know, we're not saying let's force you into prisms or flippers or 3D images. What we're doing is we're retraining the visual system. How do we make you feel safe with your tracking abilities? How do we make your tracking abilities between the two eyes get to be equal? Then how do we get your focusing power to feel safe? How do you know how far away something is from you? And once you understand how far away it is from you, how do you focus for that point in space without over focusing, without working too hard, without kind of just figuring it out? Because a lot of people figure out what they're seeing. So, you know, the patients who tell you that they can read the highway signs when they know where they are, well then you can't read the highway signs, you know, figure out what they say, but that's different than being able to read something. So how do we train them on that precision and that accuracy? All of those things are things that the majority of the population learned at home. You know, they learned through playing games. We learned our eye hand coordination and fixation abilities and tracking through playing jacks. Like, you know, we learned our gross motor abilities through twister, things like that. So, all of these things were supposed to be learned in free space anyway. So now what we're doing with our digital programs is we're going back through all of that and through all of the information that, you know, I've gotten from my experience practicing for the past 20 years and really rebuilding the visual system the way that it should have been built in the first place. So yes, I completely agree. I'm not a big fan of like computerized vision therapy. I think that oftentimes, you know, if you go to different professions, they'll have you doing like pencil push-ups and brock string way before you should be doing those things. And the visual system can't handle it. And the reason why the brain made it so that they couldn't do it is because it was safer to not be able to do it. So, to try to force somebody into this binocular posture without having that underlying foundation is going to be problematic. And that's when you have, you know, the intractable diploma. So, like the double vision that doesn't go away and things like that. And so that's not how we treat in the office or at home. We are retraining the entire visual system so the brain feels safe, has a safe place to land, that then the person can function appropriately in space. And a lot of times we'll still see that patient in the office for a vision therapy. But instead of needing to come once a week, maybe they can come once a month, which is a lot easier for somebody to do, especially if, you know, they have young kids and they have soccer and karate and ninja and all the other things like I'm, I'm a taxi driver, that is my full time job at this point. And I just see patients sometimes for fun. So. So, you know, I think that me being able to make it someplace for one, one appointment a month and doing the rest of the practice when my kids have gone to bed or before they wake up and things like that actually make sense for me. And all of the exercises that we do in our programs are in free space. So, they're interacting with real Space like the brain is designed to do. And that's how we. How we treat our patients there. And sometimes, you know, like I said, they still come into the office, and then at the end of their program, sometimes they'll come in for, like, just kind of work wrapping everything up and really, like, going hard with the lenses and prisms. Now, their assistants can handle it, but prior to their assistants being able to handle it, they don't really need to be in the office is what we found.

Denise: Yeah. You know, when you said intractable diplopia as being a thing, I'm wondering, is it actually permanent double vision when we're talking about that, or is it a matter of helping the person feel safe enough to move past that?

Dr. Collier: So, I think that with intractable diploma, True. Intractable diploma is double vision. That does not go away. Right. What you can do is you can train the brain to suppress again, because that's where it was safe. Or you could treat the underlying problem that made the brain not feel safe in the first place with using the two eyes together. So we go that second route. Let's train the brain. Like, let's raise the brain up in the right way so that they don't have intractable diploma. But if the person, you know, went right into Vector Grams and Brock String and things like that. Yes. Now you've taught them how to use their two eyes together. The brain is kind of honing in on that. And then you need to teach them how to resuppress. We had one patient who had D syndrome, so she's had it her entire life. So, eye turns in, she's one eye for distance, one eye for an ear. She has no problems. Never had double vision. She's fine. She's a lawyer, happy as a clam. She describes it as getting tapped from the back in a car accident. At that point, she was double going forward, and she was like, I didn't even hit my head. Like, I don't know how that happened. What's going on? And everybody told her it would just go away. It would go away. It would go away. It didn't go away. It was a year later; it didn't go away. So, then she found us, and what we did, it's like, okay, now, whatever happened, when your brain got jostled, it turned on your visual stream so that your brain wants to use your two eyes at the same time. So how do we make that safe for you? So, we taught her how to use her depth perception when she wanted to use perception, but to also be able to integrate her central information with her peripheral information. We weren't teaching her to. Now you need to use both eyes at all the distances. That's not where she felt safe and that's not what her goal was. Her goal was to not see double anymore, but now she has depth perception. So, we had to just treat the patient that was in front of us as opposed to treating numbers. And then she was able to go back to her one eye for distance, one eye for near, but she actually had depth perception. And now her vision was better than it was before, but it was comfortable again for her and she didn't have double vision. And so, we made a safe environment for her with this physiological eye turn that we can't do anything about. But now she's able to function again. So technically she had intractable diploma for a year, but then now she doesn't.

Denise: Okay, well, so then we have to redefine it because it's not intractable because you did something about it.

Dr. Collier: Right, exactly.

Denise: I love that too. Okay, so if someone is just finding out that they have a visual issue and they are not sure where to go, or they're maybe they're not living close enough to a developmental optometrist, or they're in a country that doesn't even have, you know, vision therapy, what kind of advice would you give them?

Dr. Collier: So first we want to have an eye exam to make sure that everything is healthy. That's our first and foremost priority, that there that things are healthy and that you're wearing the right prescription. And then I would suggest using a digital program that works in free space like ours do. And so, we want digital programs that are actually having you function in real life in a real open environment. Because those computerized programs, while they do, have benefits to them as well, because they're more fun. Like that's one of the main things is that, you know, it's like you feel like you're playing a computer game, which is great. But we want to make sure that our skills are transferable into the real world. So we do all of our programs in the real world and then we're now working with other doctors teaching them how to, you know, bottle up all of the information that they've gathered over their years of seeing patients to develop their own digital programs so that then we have even more digital programs to offer. So, we have one doctor right now who's working on a screen sighted program. So, a lot of our kids are having this screen sighted epidemic. And so, he's working on a program that's battling that. We have another doctor who's working on a sports vision program and so that he can really, you know, help these athletes get their visual skills to where they should be. Because right now, they're flying out to his office. So yes, still want you to fly out and get that hands on stuff too. But a lot of it you can do as preparation before you come out and then those sessions can be that much more productive. And so, we're kind of developing this whole ecosystem of programs so that we will be able to treat anyone, anywhere who needs vision therapy.

Denise: That is amazing. I liked what you said also about the fact that normally we would learn these skills playing in free space.

Dr. Collier: Right.

Denise: And you mentioned playing jacks or playing Twister. Do you take help your patients go home and play games also?

Dr. Collier: Some of them. So like slapjack. That's very, very fun game. It's fun. You have to really focus and, you know, you're really paying attention to your visual discrimination ability. So, your ability to tell what, which one is the jack versus which one's the king and things like that. It's your eye hand coordination. It's your ability to look at something long enough to tell what it is. So. So it's really working on your focus and attention. And the kids have so much fun with it. My kids play slapjack all the time at home and they're like, oh yeah, we're practicing our vision therapy. So, you know, whatever, call it what you want, it is true. So, I appreciate it.

Denise: I think that's fun. Well, I mean, the reason that I watch 3D movies is for vision therapy.

Dr. Collier: There you go. Right? Exactly.

Denise: Awesome. How would people get in touch with you as far as getting your program?

Dr. Collier: Yeah, so you can visit us on our website, which is 4D Vision gym.com and then there's the drop down for the home programs that are available. And that way, you know, you can really see what's available to you. You can talk to your eye doctor about it, make sure your eyes are healthy, and then start training your visual system.

Denise: Okay. One of the things that came up for me with having the right prescription is that I feel like sometimes doctors will prescribe a prescription that's different than what you would prescribe as a vision therapy doctor. Does that come up when you're saying, go get your regular doctor to give you a prescription and then you can use this program? Does that ever conflict with what you're trying to do?

Dr. Collier: So ideally, everyone would go to a behavioral, developmental, neuro, optometrist. You know, and there's not a lot of us. So, in Connecticut, I believe there's five of us, you know, so not, that's not always an option. The first step would be to go to a behavioral competition if you can, but if you cannot, then you still need to be wearing glasses. Like, you know, we still need to make sure that you're seeing appropriately, that, you know, if you do have one eye that's significantly more near sighted than the other, we can't really work on your depth perception if your two eyes aren't looking at the same point in space. So usually, they're not going to be grossly off. So, you know, yes, there's times when it is, but most likely it's going to be close enough. Like you're probably going to have a little bit more nearsighted prescription than you need. Like, that's the thing that we see the most. But for the most part it's going to be relatively close. And then when you go back to that doctor for a follow up or something, they'll decrease your prescription because most of our patients, their prescription's going down as they progress through the program. So, they will make the adjustments. So, you know, I have faith in my colleagues out there.

Denise: Great. Well, do any of them prescribe prisms? And then that's a problem because I've talked to doctors who use smaller prism prescriptions in behavioral optometry than maybe a regular optometrist or ophthalmologist would use.

Dr. Collier: So, most doctors, optometrists who are comfortable prescribing prism are pretty good at it. You know, a lot of optometrists won't prescribe prism because they're not comfortable with it. So again, like, I have faith in my colleagues that they'll do, they'll work within the confines of what they're comfortable with. I'm not going to treat glaucoma. That's not my thing. I will refer out for that every single day. But that's not. I do vision therapy, nothing else. I don't sell glasses. I do nothing but vision therapy. And so, you know, if I started going rogue and treating glaucoma, then that's a problem. Just like, you know, so if you're a doctor who's specializing in glaucoma and you don't really refract, you don't deal with strabismus, you don't deal with binocular vision issues, and you're prescribing prison, then that's probably not what you should be doing. So, the doctors who are comfortable doing it, then that's fine. And like I said, when the patients go back before their follow ups, they'll modify the prescriptions.

Denise: Okay. Because they wouldn't need the prism after they've done your program, most likely, or

Dr. Collier: they'll need a lesser amount. So, it depends on, you know, what exactly they're coming in with. And so, some strabismic patients are always going to be a little bit more comfortable with some prism. But my concern is when it's leaving the area of optometry. So, a lot of other professions are realizing how important vision therapy is and the visual system is and how important visual development is, which is great. And that means that we're finally like, we're achieving our goal that we were talking about before is like really getting, getting the information out there and people understanding what's going on. But because there are so few behavioral optometrists, a lot of other professions are, you know, trying to help their patients. And so, they're kind of stepping outside of what they were trained in to do what they can to help the patients in front of them. And if you don't really know the inner workings of the visual system, then you can make things a lot worse. So, we're seeing some patients coming in from other professions with, you know, tapes on their glasses. And yes, optometrist, behavioral optometrist will do binasal tapes, bi temporal tapes. You know, we'll do things with the tape, but we know why we're doing it. So, if somebody's doing it and they're like, oh, I saw this work once, or I went to a conference, and this is how they did it. So, I. Let me try it on this patient. We've seen it make patients so much worse, so nauseous, not being able to drive things like that because somebody that wasn't as trained was trying to help them. And that's why, you know, for me, it's like, go to an optometrist, at least they're not going to do anything crazy. And then work with our program so that we can actually rebuild your visual system. Because anything that's a little bit too much intervention that that's not really guided can make things significantly worse and a lot harder to treat.

Denise: Yeah, I love that you brought that out too. I think it's so important for people to just be aware that you got to talk to the right people.

Dr. Collier: Exactly. Exactly. Yeah. Because behavioral optometry isn't that accessible and there's a lot of other professions that are, you know, you just throw a stone and you. And you hit one, which is great. And also, we need to think about who was the most trained for that. That thing that you're dealing with. Because for us, you know, for me, a convergence insufficiency patient, like, I don't even need to be awake to treat them. You know what I mean? So, it's kind of like, this is just what I do. But for somebody else, that might be something where they're like, oh, well, let's see what this prism does, or let's see what this does and all of these things. And now you turn that person into a strabismic patient, or, you know, you've gotten rid of their depth perception, or you've given them headaches, or you've given them double vision when they were reading, when before they didn't have double vision. So, you know, we want to make sure that it's not just enough knowledge to hurt somebody. Right.

Denise: Just enough to be dangerous is what

Dr. Collier: exactly that looks like.

Denise: Yeah, absolutely. Okay. Well, I think that what we've talked about today is going to be really helpful for people. And I love that you're so passionate and so involved, and I think it. That's so often the case that someone who experiences it themselves is the more passionate person. Right. Is looking for the answers that are going to help other people who struggle. Like they struggled.

Dr. Collier: Exactly, exactly. The kids love it when I show, like, when I make my eye turn out. Like, see my eye does it. Oh, wow. Because now I have full control, so I can turn it out. I can turn it wherever you want me to turn it. And so it's like, you know, they feel that kindred spirit there that it's like, oh, yeah, I'm not just talking. I fixed it. I'll fix you. We're good. Don't worry about it.

Denise: Yeah. That's awesome. I love it. Do you have anything else that you want to share with people before we're done? I know you need to get to your practice.

Dr. Collier: Yeah. I think that, you know, just really looking if something doesn't seem right, trusting yourself. And if a doctor tells you that, no, everything's fine, but you know that it's not. If it's for you or yourself or your child, for your parent, trust yourself. Because, you know, we know things, and we might not know how to fix them. We might not know exactly what's going on, but we know if something's right or wrong. And so, trust yourself and go seek out the help for that person. That you're trying to make life better for.

Denise: Yeah, I love that. You know, I think you're the first person who's talked about advocating for your parent, and I love that too, because I think we decide that they must know better because they're our parent. But the visual system changing is a problem all the way through our life. Right. And so, we just have to be aware that we can recognize that there's a problem. We can recognize that we can ameliorate that problem.

Dr. Collier: Right. Exactly.

Denise: We can definitely make things better than they have been. And I love that you're sharing that with everyone.

Dr. Collier: Me too. Thanks.

Denise: Thanks for listening to the Healing Our Sight podcast today. I'd love to connect with you. You can leave a comment by clicking the link in the show notes. I love receiving your messages. You're also invited to join the Healing Our Sight Facebook group. Let me know what resonated with you and how I can better serve you.